Provider First Line Business Practice Location Address:
64-957 MAMALAHOA HWY
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
KAMUELA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96743-8415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-887-2828
Provider Business Practice Location Address Fax Number:
808-887-1236
Provider Enumeration Date:
11/21/2005